What is it?

Human immunodeficiency virus (HIV) is the virus that causes acquired immune deficiency syndrome (AIDS). AIDS is a disease that attacks the body's immune system. The immune system is our body's natural defense system and allows us to fight off viruses, bacteria and other diseases.

HIV was first reported as a threat by the U.S. Centers for Disease Control and Prevention (CDC) in 1981 and now is a worldwide problem. When HIV was discovered, it was diagnosed almost entirely in men. Now, one in four people living with HIV are women.

The good news is that HIV is much more manageable than in the past. Originally, HIV was practically a death sentence. Few drugs were available to treat the virus, and resulting infections attacked the weakened immune system. Since then, a number of drugs have been developed and approved to treat both HIV and its related infections. These medications have extended the lives of many people living with the disease.

But the drugs used to manage HIV certainly aren't perfect. And they come with side effects that range from nausea and vomiting to life-threatening reactions. Therefore, all people—men, women, teenagers and even people over 50—need to be careful about protecting themselves from being infected with the virus in the first place.

HIV differs from most other viruses because antibodies produced by the immune system cannot kill HIV. Once a person is infected, HIV remains in the blood forever. In a person who isn't treated, the virus eventually weakens the immune system to where it can no longer protect the body from infections. This internal battle can last 10 years or more. Infections such as Pneumocystis carinii pneumonia (PCP), Mycobacterium avium complex (MAC) and cytomegalovirus (CMV) can take over in the late stages of AIDS. In addition, patients with HIV face an increased risk of contracting certain cancers and neurological disorders.

Since the beginning of the AIDS epidemic in the mid-1980s, HIV infections among U.S. women have increased, especially in women of color. In 1985, only a small percentage of people living with AIDS were female. Today, women make up 24 percent. The good news is that infections among U.S. women began decreasing in 2001.

Even though the rate of diagnosis for African American women has decreased significantly since 2001, it remains 20 times the rate for white women. African-American women represent about 13 percent to 14 percent of all U.S. women and, yet, account for 64 percent of AIDS cases in women. Hispanic women, who represent about 17 percent of U.S. women, make up 15 percent of women with AIDS. White women, who represent about 80 percent of U.S. women, account for only 18 percent of AIDS patients.

The higher infection rate for women of color may be due to multiple factors including: lack of HIV knowledge, lower perception of risk, drug or alcohol use, and different interpretations of safer sex, according to the CDC.

The death rate due to HIV/AIDS is also higher in women of color. According to the CDC, deaths due to HIV infection were among the top 10 leading causes of death for African-American females aged 10 to 54 and Hispanic/Latina females aged 15 to 54.

Thanks to new antiretroviral drugs, HIV has turned from a terminal illness into one that can be managed over decades in many cases, much like diabetes or high blood pressure. But the antiretroviral drugs do have potentially serious side effects.

Although the number of AIDS infections in this country has remained fairly constant at around 50,000 cases a year, there are more people living with HIV than ever before. In 2010, the most recent year for which prevalence data are available, there were about 1.1 million U.S. adults and adolescents living with HIV infection, and almost one in five are unaware of their infection..

At the same time, relaxed attitudes about using barrier protection has health officials worried. New studies have identified disturbing increases in HIV infection among young gay men and high-risk adolescents. Health officials believe this may be because of over-optimism about HIV treatment.

This relaxed attitude toward prevention has led to an upswing in AIDS cases in this younger age group over the past few years. According to the CDC, young people aged 13 to 29 made up 39 percent of all new HIV infections in 2009. There was an estimated 21 percent increase in HIV incidence in people aged 13 to 29 between 2006 and 2009, driven in part by a 34 percent increase in HIV infection in young men having sex with men.

HIV is transmitted through the blood, semen and vaginal secretions of an infected person. Here are the important facts about how HIV is transmitted:

The virus is mainly spread by unprotected sex and sharing needles with an HIV-infected person.

Babies born to HIV-infected women may become infected before or during birth, or shortly after birth through breast-feeding if preventive measures aren't taken.

You cannot become infected with HIV through casual contact or insect bites or stings.

Only a few cases of HIV have been transmitted in household settings. They are believed to have occurred when infected blood or other body fluids came in contact with skin or mucous membranes.

Casual contact through closed-mouth or "social" kissing is not a risk factor for transmission of HIV. However, experts recommend against "French" or open-mouthed kissing with an infected person because of the increased possibility of contact with blood-contaminated secretions.

The presence of oral or genital sores from other sexually transmitted diseases (such as herpes or syphilis) increases the risk of sexual transmission of HIV.

The risk of acquiring HIV from an infected health care professional is extremely low.

Female-to-female transmission of HIV appears to be low. However, case reports of female-to-female transmission of HIV indicate that vaginal secretions and menstrual blood are potentially infectious and that mucous membrane (e.g., oral, vaginal) exposure to these secretions has the potential to lead to HIV infection.

HIV is at least four times more transmissible to women than to men.

Diagnosis

Diagnosis

Many people report no symptoms when they are first infected. That is why it is important to ask your health care provider about testing if you have risk factors, such as:

Having unprotected sex with multiple partners

Sharing needles with an HIV-infected person

Having unprotected sex with bisexual men or men who inject drugs

Having other sexually transmitted diseases, such as herpes, syphilis or gonorrhea.

Some people do have initial symptoms, called acute retroviral syndrome or primary HIV infection. The symptoms are similar to those of mononucleosis—such as fever, fatigue, joint ache, headache and sore throat—and last for one to three weeks. When primary HIV infection is recognized, starting treatment at this point may help control progression of infection down the road.

There are several types of tests available to test for the presence of HIV antibodies. The first tests were introduced in 1985 to screen donated blood. Now they are also used to evaluate people at risk of HIV infection. The two standard HIV tests are the enzyme immunoassay (EIA), also known as ELISA, and the Western blot (WB).

The EIA/ELISA detects antibodies produced in response to HIV infection. The test can be done using blood, oral fluids or urine, though the urine test is less accurate. If this test is positive, the same test is repeated. If the repeat test also reveals HIV antibodies, it is followed up with the Western blot test, which checks for the presence of HIV proteins. Confirmation with the Western blot is important because some people have non-HIV antibodies that can cause a false positive result on the EIA test. The downside of these tests is that they can take up to two weeks to get the results.

That's why the FDA has approved several rapid tests, all of which give results within 20 minutes. These tests look at blood, plasma or saliva to check for the presence of HIV. Similar to EIA screening tests, these rapid tests must be confirmed with a follow-up confirmatory test before a final HIV diagnosis is made. Rapid tests are similar in accuracy to traditional EIA tests.

The FDA has also approved a few over-the-counter HIV tests that are available in many drugstores and can be performed in your home. One of these tests, OraQuick, uses saliva. The rest use blood obtained with a lancet and placed on a filter strip. The sample is mailed in a protected envelope using an anonymous code. You receive test results by making a toll-free call. If the result is negative, you will hear a prerecorded message; if it is positive, you will receive counseling and be referred to a health care professional.

RNA tests are also available that look for genetic material of the HIV virus. These tests can be used to screen the blood supply and to detect rare instances of very early infection, when antibody tests are not yet able to detect HIV.

No matter which type of HIV antibody test you take, if it is negative, you are either uninfected or in the early stages of infection before your body produces HIV antibodies. It can take up to six months—longer, in rare cases—for the body to produce detectable amounts of HIV antibodies. This early period is called seroconversion. Some refer to this time as the "window period" since it offers a window of opportunity for people to unknowingly infect others.

In some cases, an HIV antibody test result is indeterminate or equivocal, meaning HIV antibodies have not yet fully developed. If an indeterminate reading continues for six months or longer, you are considered uninfected.

Treatment

Treatment

When the human immunodeficiency virus (HIV) emerged in the early 1980s, it was considered a death sentence because there were few drugs available to treat the virus and resulting opportunistic infections. Since then, a number of drugs have been developed and approved to treat both HIV and its opportunistic infections.

These medications have extended the lives of many people living with HIV, including children. None of these medications offers a cure for HIV, though, and they are expensive and have severe side effects. And, unfortunately, some people develop a resistance to the drugs after being on them for a long time. They are not an easy solution to infection with HIV.

HIV treatment continues to change rapidly. New therapies, different combinations of drugs and improved methods for monitoring infection make treatment increasingly complex. There are three important facts about treatment for HIV:

It is available even for many HIV-infected persons who don't have symptoms yet.

It can delay progression to AIDS and prolong life.

It changes all the time, making it critical to remain current with the latest findings.

That's why it's important that you find an HIV specialist to care for you. Given the speed with which the field changes, many general practice physicians cannot keep up with the latest treatment advances. Being HIV-positive, you may also face unique psychological and social challenges, such as whom to notify, how to handle your feelings, when to start treatment and where to find financial assistance. These are issues that AIDS specialists are familiar with.

An AIDS specialist, typically an infectious disease doctor, will also know the unique ways in which HIV infection impacts a woman's health. For example, HIV-infected women are more likely to experience certain gynecological disorders than HIV-negative women and are much more likely to have abnormal Pap smears. Consequently, HIV-positive women should have a Pap test twice within the first year after their initial HIV diagnosis. If both Pap tests are normal, they can then resume annual Pap tests.

The overall goal of HIV/AIDS treatment is to reduce the amount of virus in the bloodstream to a level so low it cannot be detected. Indeed, having "undetectable" virus has become the benchmark for measuring a successful therapy regimen. An undetectable virus does not, however, mean that you're cured or that the virus is completely out of your body.

Another benefit from HIV treatment is its potential to prevent the serious opportunistic infections that make AIDS a debilitating condition.

With the advent of a class of drugs called protease inhibitors in the mid 1990s, a new model was introduced for treating HIV infection. These powerful drugs used in different combinations have allowed patients once disabled by AIDS to return to work and remain free from serious symptoms. This model uses a combination of at least three drugs from two or more classes, called combination therapy, or a "drug cocktail."

Prior to these powerful drugs, the primary treatment was zidovudine, known as AZT. Patients usually responded to AZT for a little while, but became sick again once the virus mutated and could survive the drug's effects. These mutations also occur with other drugs used to treat HIV.

Drug therapy with protease inhibitors works to interrupt HIV replication by interfering with an enzyme known as HIV protease. By keeping the virus in check, the drugs can delay the gradual weakening of the immune system.

Additionally, treatment may reduce the chance that an infected person will transmit the virus; if they're effective, the drugs not only reduce the amount of virus in the blood but in bodily fluids, as well.

Finally, people who start early treatment with powerful drug combinations can delay symptoms of infection longer than those not receiving treatment.

So, when should antiretroviral treatment be initiated for an HIV-infected patient? The latest thinking in the medical community is that, in most cases, treatment should be started as soon as possible following HIV diagnosis. However, each case is different, so you should discuss the best time to start treatment with your health care professional. Together, you and your health care professional should consider factors such as how well your immune system is functioning, whether you are pregnant, whether you have AIDS, the amount of HIV in your blood and your ability and willingness to commit to lifelong treatment.

If you have HIV/AIDS, you should be active in your treatment—discuss the risks and benefits of all therapy options with your health care professional so you can make the most informed decision.

Before protease inhibitors, many AIDS patients were given antibiotics to ward off Pneumocystis carinii pneumonia (PCP) and Mycobacterium avium complex (MAC). Combination drug therapy has allowed many people to stop taking preventive therapy for these AIDS-defining opportunistic infections.

Research has shown that HIV treatment can dramatically reduce the risk of a mother transmitting the virus to her baby. Without preventive therapy, about 25 percent of all HIV-positive pregnant women in developed countries pass the virus on to their babies. When women and their infants receive antiretroviral drugs during pregnancy and delivery, the risk of transmission drops to less than 2 percent.

With the availability of an effective means of preventing perinatal infection, health care providers are urged to screen all pregnant women for HIV, regardless of individual risk factors. The CDC also recommends postnatal screening for infants not tested before they're born.

Today, there are five main classes of antiretroviral drugs approved for HIV therapy. They include the following:

Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) were the first antiretrovirals developed for treatment of HIV. These drugs interfere with an enzyme that enables the virus to replicate. NRTIs include lamivudine (Epivir), Combivir (AZT/3TC) and Hivid (Zalcitabine, ddC). A newer drug in this class, called emtricitabine (Emtriva), treats both HIV and hepatitis B. It must be used together with at least two other AIDS medications.

Protease inhibitors, discussed above, prevent the HIV virus from copying itself after entering a cell. By interfering with an enzyme called HIV protease, they prevent the virus from replicating at a later stage in its life cycle. They include saquinavir (Invirase), ritonavir (Norvir), indinavir (Crixivan) and nelfinavir (Viracept), among others. To help prevent resistance, protease inhibitors are usually prescribed with other medications.

Entry inhibitors(also called fusion inhibitors) block the virus from replicating by preventing its membrane from fusing with healthy cells. They appear to suppress the most drug-resistant strains of HIV. The two FDA-approved entry inhibitors are enfuviritide (Fuzeon) and maraviroc (Selzentry). These drugs, which are prescribed with other HIV drugs, are used for people who have developed resistance to other HIV drugs or who have an advanced HIV infection.

Integrase inhibitors, similar to entry inhibitors, are designed to treat people with HIV who have developed a resistance to other treatments. They work by preventing HIV DNA from integrating into human DNA. So far, there is only one drug in this class—raltegravir (Isentress)—which is used in combination with other antiretroviral drugs.

To be most effective, researchers have discovered that HIV medications must be given in combination. The HIV virus can quickly mutate and become resistant to single medications, so the virus needs to be attacked in different ways with different drugs at the same time to be kept under best control. In the past, HIV patients were forced to take multiple antiretroviral medications in multiple pills. Now there are three FDA-approved HIV medications that offer a full combination (or "cocktail") of drugs in one pill. These medications are often referred to in the medical community as multiclass therapies, and they include the following:

Stribild (Elvitegravir/Cobicistat/FTC/Tenovir), approved in August 2012

Complera (Rilpivirine/Tenofovir/FTC), approved in August 2011

Atripla (Efavirenz/Tenofovir/FTC), approved in 2006

These multiclass, one-dose medications combine two or more of the five classes of HIV drugs described above.

All AIDS medications carry the potential for toxicity, known as adverse drug reactions. For example, protease inhibitors can redistribute fat cells in some patients. This condition, called lipodystrophy, causes paunches or humps to form in the abdomen or back. Some side effects are life threatening, such as the hypersensitivity reaction associated with abacavir and the inflammation of the pancreas that can occur with stavudine and didanosine. More common side effects from antiviral drugs are headache, fever, rash, nausea and vomiting.

You must also watch for the risk of adverse drug interactions, both with anti-HIV drugs and other pharmaceutical and recreational drugs. An interaction can occur when two anti-HIV drugs have similar side effects. For instance, both zalcitabine and didanosine may cause tingling or pain in the hands, feet and legs, so they shouldn't be prescribed together.

Interactions between anti-HIV drugs and other drugs can make anti-HIV drugs less effective and cause undesirable reactions. The tuberculosis treatment rifabutin, for example, should not be used with the protease inhibitor saquinavir for this reason. This is one more reason you should receive treatment from a provider experienced in HIV care and make sure you tell your health care professional about any medication—prescription or over-the-counter—you're taking, including alternative medicines, supplements, vitamins and minerals.

Your treatment response will be assessed with a tool called a viral load test. The test measures the amount of HIV in your blood—in medical terms, "plasma HIV RNA"—and is quantified as "copies per milliliter." The goal is a viral load below 400 copies per milliliter of blood.

Viral load testing is an invaluable treatment guide today in the same way a CD4 count (testing for white blood cells called T-lymphocytes) was in the first decade of the epidemic. It provides timely information for deciding when you should start treatment and when to switch to different drugs if treatment proves ineffective or resistance is developing. The CD4 test is still important for measuring the functioning of the immune system.

Prevention

Prevention

In the United States overall, HIV is most commonly acquired from homosexual sex; among women, it is most commonly acquired through heterosexual sex. The primary means of prevention and the primary focus of public health officials throughout the epidemic have been on the use of barrier contraceptives—condoms, male or female.

And although they provide some protection against HIV infection, condoms are not foolproof—the only surefire way to prevent HIV is to abstain from having sex with anyone who is infected, even if they may not know they're infected.

One approach to HIV prevention that is gaining support is called the "ABC" approach, in which A stands for abstinence or delay of sexual activity, B for being faithful and C for condom use. This idea implies monogamy and reductions in casual sex and multiple sexual partnerships.

This approach is the primary reason behind the ability of Uganda and Thailand to reverse their HIV epidemics.

In other words, to reduce their risk of HIV, women need to stop having sex with multiple partners, stop having casual sex and engage in intercourse only as part of a committed, monogamous relationship whenever possible.

Other preventive behaviors include:

Always use a condom (male or female) from start to finish during any type of sex (vaginal, anal and oral). Use latex or polyurethane condoms, not "natural" condoms.

Use only water-based lubricants with latex condoms. You can use non-water-based lubricants with polyurethane condoms. Do not use oil-based lubricants such as petroleum jelly or vegetable shortening.

If you use a spermicide with a condom, use the spermicide in the vagina according to the instructions. Spermicides have not been shown to protect against HIV.

Avoid contraceptives containing the spermicide nonoxynol-9. Over-the-counter contraceptives that contain the spermicide nonoxynol-9, such as foams, creams, and gels, do not protect against HIV infection or other STDs. In fact, vaginal contraceptives containing nonoxynol-9 can promote vaginal irritation, which may increase your risk for HIV and other sexually transmitted diseases.

Don't do anything that could tear the skin or moist lining of the genitals, anus or mouth and cause bleeding. For instance, trauma to the mouth caused by rough kissing could lead to an exchange of blood.

Avoid alcohol and illicit drugs. Alcohol and drugs can impair your immune system and your judgment. If you use drugs, do not share needles, syringes or cookers.

Do not share personal items such as toothbrushes, razors and devices used during sex that may be contaminated with blood, semen or vaginal fluids.

Seek early diagnosis and treatment if you have any symptoms of sexually transmitted diseases. Other sexually transmitted diseases may increase your risk of HIV infection.

Realize that you cannot tell by looking who is HIV-infected. In fact, a person can be infected and go years without any symptoms. During this time, they are still infectious.

For those already infected, combinations of antiviral drugs may reduce the ability to transmit the virus to a partner, with research finding that the drugs reduce the amount of virus in bodily secretions. Until the impact of treatment on transmission has been determined by large studies, however, this should not be considered a form of prevention.

For women who have sex with other women, the risk of HIV transmission is small. However, surveys of risk behaviors within some groups of such women indicate relatively high rates of high-risk behaviors, such as injection drug use and unprotected vaginal sex with gay/bisexual men and injection drug users. To minimize risk, you should:

Understand that exposure of a mucous membrane, such as the mouth (especially if there is a cut), to vaginal secretions and menstrual blood is potentially infectious, particularly during very early and late-stage HIV infection when the amount of virus in the blood tends to be highest.

Use dental dams, cut-open condoms or plastic wrap to help protect from contact with body fluids during female-to-female oral sex.

Researchers are working hard to find other ways to prevent HIV transmission. Two of the most promising are vaccines and antimicrobials. Neither, however, is expected to reach the market for many years.

Facts to Know

Facts to Know

The CDC reports that 619,400 people in the United States have died from AIDS between the start of the epidemic in 1981 and 2009 (the most recent year for which death data are available). In 2010, an estimated 1.1 million people were living with AIDS in this country.

Today, about a quarter of people living with HIV are women.

According to the World Health Organization, as of November 2010, 34 million people were estimated to be living with HIV/AIDS worldwide. Of these, 31.6 million were adults, 15.8 million were women and 390,000 were children.

During 2010, AIDS caused the deaths of an estimated 1.8 million people worldwide.

The overwhelming majority of people with HIV now live in the developing world.

HIV infection can be passed from a mother to her baby before or during birth and through breastfeeding. In the United States, without antiretroviral drugs, 25 percent of women will transmit the virus to their children. When women and their infants receive antiretroviral drugs during pregnancy and delivery, the risk of transmission drops to 2 percent or less.

Many people report no symptoms when they are first infected. However, some people have initial symptoms, called acute retroviral syndrome or primary HIV infection. The symptoms are similar to those of mononucleosis—such as fever, fatigue, joint ache, headache and sore throat—and last for one to three weeks.

Improved drug treatment for HIV infection allows people to live longer before developing AIDS. The drugs have allowed many people to stop taking preventive therapy for AIDS-defining opportunistic infections such as Pneumocystis carinii pneumonia and Mycobacterium avium complex.

There are five main classes of drugs used to treat HIV infection. The drugs are used in combination with each other to help prevent resistance. There are now three FDA-approved medications that provide a combination of drugs in a single pill.

The riskiest behavior when it comes to HIV transmission is sharing needles to inject drugs with someone who is HIV infected. The next riskiest behavior is anal sex, followed by vaginal sex. You should never have unprotected anal or vaginal sexual intercourse with anyone whose HIV status you are unsure of.

Questions to Ask

Questions to Ask

If you are HIV positive or living with AIDS, review the following Questions to Ask and discuss them with your health care professional.

Do you have experience treating HIV/AIDS patients? About how many HIV/AIDS patients have you treated? Are you an HIV/AIDS specialist?

How soon should I begin treatment for AIDS? What are the pros and cons of starting drug therapy soon after I am infected with HIV?

What are the main side effects of antiviral drugs?

Once I start treatment, do I have to continue taking the drugs for the rest of my life?

What is my viral load (the amount of virus in my blood) and my CD4 count? What do they tell me about my illness?

Are there alternative therapies I can consider?

If I get pregnant, can I still deliver a healthy baby? How can I protect my baby from AIDS?

Should I avoid breastfeeding my baby if I have AIDS? Why?

What are the chances of my sexual partner becoming infected if we use condoms?

I need to talk to other people with AIDS, who understand what I'm going through. Where can I find a support group?

How does HIV infection affect my risk for developing infections and other complications?

How can I keep up with new advances in fighting HIV/AIDS?

Key Q&A

Key Q&A

How long does it take for HIV to cause AIDS?

There is no single answer to this question because it depends on many factors, including a person's health status and his or her health-related behaviors. Before antiretroviral therapy became available in 1996, experts estimated that half of people with HIV would develop AIDS within 10 years. Scientists estimate that improved treatments will extend the time it takes to develop AIDS well beyond 10 years.

How can I tell if I'm infected with HIV?

The only way to determine for sure whether you are infected is to be tested for HIV infection. You cannot rely on symptoms alone to let you know if you are infected with HIV, because most infected people may not have symptoms for years after their initial infection. Some symptoms that may be warning signs of infection include rapid weight loss, recurring fever, swollen lymph glands, pneumonia and diarrhea for an extended period.

Why is HIV testing recommended for all pregnant women?

There are medical therapies available to lower the chance of an HIV-infected pregnant woman passing HIV to her infant before, during or after birth. HIV testing and counseling also provide an opportunity for infected women to find out they are infected and to gain access to medical treatment that may delay HIV disease progression in themselves.

Can I get HIV from someone performing oral sex on me?

Yes, it is possible for you to become infected with HIV through receiving oral sex. If your partner has HIV, blood from his or her mouth may enter the urethra, the vagina, the anus or directly into the body, through small cuts or open sores. While no one knows exactly what the degree of risk is, evidence suggests that the risk is less than that of unprotected anal or vaginal sex and comparable to deep "French" kissing.

Can I get HIV from getting a tattoo or through body piercing?

A risk of HIV transmission does exist if instruments with blood are either not sterilized or disinfected or are used inappropriately between clients. If you are considering getting a tattoo or having your body pierced, ask staff at the establishment what procedures they use to prevent the spread of HIV and other blood-borne infections, such as hepatitis B virus.

Can I get HIV from open-mouth kissing?

Open-mouth kissing, or "French kissing," is considered very low risk for HIV transmission. However, prolonged open-mouth kissing could damage the mouth or lips and allow HIV to pass from an infected person to a partner. Because of this possible risk, experts recommend that you refrain from open-mouth kissing with an infected partner.

Why is injecting drugs a risk factor for HIV?

At the start of every intravenous injection, blood is introduced into needles and syringes. HIV can be found in the blood of a person infected with the virus. The reuse of a blood-contaminated needle or syringe by another injection drug user carries a high risk of HIV transmission because infected blood can be injected directly into the bloodstream.

How effective are latex condoms in preventing HIV?

Studies have shown that latex condoms are highly effective in preventing HIV transmission when used consistently and correctly. Nonetheless, the use of condoms alone cannot stem the tide of the AIDS epidemic. Reducing your sexual partners and taking a monogamous approach may also be necessary.

Lifestyle Tips

Lifestyle Tips

Realize that HIV knows no age limits

The rate of AIDS among those 50 and older is still increasing, both as a result of older people becoming infected with HIV and living longer with the virus. In 2010, an estimated 7,797 HIV diagnoses—16 percent of all diagnoses—occurred in people age 50 and older. So if you're newly divorced, still single or just between relationships, you need to use condoms and take appropriate precautions, regardless of your age. Another good idea is to make sure you and your partner have negative HIV tests (as well as tests for other STDs) before becoming intimate.

Take precautions for oral sex

Although unprotected oral sex is presumably safer than unprotected anal sex or vaginal intercourse, it is no guarantee of protection against sexually transmitted diseases. Most sexually transmitted diseases can be spread via oral sex. To protect yourself, make sure your partner uses a condom if you're performing oral sex; if he's performing oral sex on you, or if you're having oral sex with a woman, use a dental dam, a flat piece of latex used during dental procedures. You can get them in some medical supply stores. They provide a barrier between the mouth and the vagina or anus during oral sex. Household plastic wrap or a split and flattened unlubricated condom can also be used if you don't have dental dam. Also, don't brush or floss your teeth right before having oral sex. Either may tear the lining of your mouth, increasing your exposure to viruses.

Practice the best protection

The best protection against any type of sexually transmitted disease is a latex condom. However, it doesn't provide 100 percent protection against STDs—only abstinence does. If you use a condom, make sure you use it properly. Human error causes more condom failures than manufacturing errors. Use a new condom with each sexual act (including oral sex). Carefully handle it so you don't damage it with your fingernails, teeth or other sharp objects. Put the condom on after the penis is erect and before any genital contact. Use only water-based lubricants with latex condoms. Ensure adequate lubrication during intercourse. Hold the condom firmly against the base of the penis during withdrawal, and withdraw while the penis is still erect to prevent slippage.

Get tested for STDs

No one test screens for all STDs. Some require a vaginal exam and Pap smear; others require a blood or urine test. You can get tested at your health department, community clinic, private health care professional or Planned Parenthood. Or call the CDC at 1-800-CDC-INFO (800-232-4636) for free or low-cost clinics in your area.

Know whether you have an STD

While some STDs may present with symptoms such as sores, ulcers or discharge, many have no symptoms. You can't always tell if you or a partner has an STD just by looking at him or her, particularly in women. Don't rely on a partner's self-reporting and assume that will prevent you from acquiring an STD; many infected people do not know they have a problem. They may think symptoms are caused by something else, such as yeast infections, friction from sexual relations or allergies. Educate yourself about your own body and, in turn, learn about your own individual risk for contracting an STD. One way to do this is to schedule an examination with a health care professional who can sit down with you and help you learn the principles for staying safe and sexually healthy. Don't allow fear, embarrassment or ignorance to jeopardize your future.

Talk to your children about STDs

Sexually transmitted diseases are particularly common among adolescents. Teens should be concerned about STDs and know how to protect themselves. As a parent, you can play a large role in your adolescent's behavior, both through the behavior you model and your communication with your teen. Make sure your daughter regularly visits a competent gynecologist and your son sees a medical professional who specializes in adolescent health at least once a year, if for nothing else than some plain talk about STDs and pregnancy. And talk to your kids. Study after study proves that when parents talk to their kids about sexual issues, their kids listen. Don't worry that talking about sex is the same as condoning it. Studies show that when parents talk about sex, children are more likely to talk about it themselves, to delay their first sexual experiences and to protect themselves against pregnancy and disease when they do have sex.

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"Leading Causes of Death in Females—United States, 2002." The Centers for Disease Control and Prevention. March 2005. http://www.cdc.gov. Accessed June 2006.

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